management of cervical spondylosis/cervical disc prolapse

Conservative measures may be sufficient for the treatment of cervical spondylosis, including:

non-steroidal anti-inflammatory drugs if not contraindicated
analgesia
if muscle spasm then a short course of a muscle relaxant such as diazepam may be of benefit
during the initial phase, heavy lifting must be avoided
other possible interventions include:
- a rigid neck collar can be beneficial - however only in the short term (no more than about a week). Even where myelopathy has occurred, around 50% of affected patients will improve with the use of a collar (1)
- physiotherapy
even where it is obvious that a disc herniation has occurred, the principle of first treatment is the same as for a lumbar disc herniation, namely conservative
- over 95% of patients with acute cervical discs causing radiculopathy will respond to 4–6 weeks of such therapy
- the presence of minor or stable neurological deficit does not preclude medical treatment, or dictate surgery
- affected patients must be reviewed regularly to assess neurological progress, or otherwise. If deterioration is seen, referral is required as surgery may be necessary
- as spondylotic symptoms and signs are episodic, conservative measures are beneficial during periods of exacerbation

Operative procedures carry significant risks. Surgical review is indicated if:

abnormal neurology, or persistent or progressive brachialgia with or without abnormal neurology
intermittent arm pain (brachialgia) rarely warrants surgery
more details concerning indications for surgical review are included in the linked item.

Surgical procedures include:

removal of osteophytes
laminectomy - usually, a wide decompression, e.g. from C3 to C7
foraminectomy - decompression of nerve root at one or more levels after drilling away overlying bone
all these procedures are usually combined with spinal fusion

Note:

surgery is good at reducing compressive nerve root symptoms and signs
- symptomatic resolution can be expected in 75–90% of patients after cervical root decompression
surgery is also good at arresting myelopathic progression.
surgery is less good at reducing myelopathic symptoms and signs when these are chronic

Reference:

Last reviewed 01/2018

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